Provider Demographics
NPI:1063917912
Name:COLE, TAYLOR ANNE
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ANNE
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 THIRD AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1300
Mailing Address - Country:US
Mailing Address - Phone:619-271-7992
Mailing Address - Fax:619-271-7970
Practice Address - Street 1:3539 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-7032
Practice Address - Country:US
Practice Address - Phone:619-818-3788
Practice Address - Fax:619-795-6906
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA103766106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program